Safety and feasibility of lumbar spine for intralaminar screw fixation : a computed tomography-based morphometric study

Objective: The use of intralaminar screws (ILS) in spinal surgery has experienced a recent increase in popularity. The aim of this study is to define the morphological parameters of the lumbar laminas so that guidance may be defined for ILS placement.Methods: The study involved the evaluation of lumbar computed tomography (CT) images of patients. Two hundred thirty-five patients (127 male, 108 female) were included in the study. The mean patient age was 44.2 years (19-78 years). The measured parameters of the lamina were the transverse inner diameter, transverse outer diameter (lamina width), lamina length, subdural space (safe zone), and spinolaminar angle for each lumbar level (L1-L5).Results: The mean transverse outer diameter (L1-L5) ranged from 7.2-7.8 mm, and mean transverse inner diameter ranged from 2.5-3.0 mm. The lamina of L3 had the largest width and the lamina of L1 and L5 the smallest. The mean lamina length was 26.6 mm, ranging from 21.0-34.0 mm, and the mean spinolaminar angle was 124.7°, ranging from 111-135°. The L1 level had the shortest mean lamina length and L4 the lowest spinolaminar angle. Mean subdural space (safe zone), which was narrowest at the L5 level, was 2.4 mm, ranging from 1.3-3.6 mm.Conclusion: ILS of the appropriate size (3.5-4.5 mm) and length (20 and 25 mm) can be used safely in the lumbar spine. However, further biomechanical studies should be performed to measure strength of the fixationObjective: The use of intralaminar screws (ILS) in spinal surgery has experienced a recent increase in popularity. The aim of this study is to define the morphological parameters of the lumbar laminas so that guidance may be defined for ILS placement.Methods: The study involved the evaluation of lumbar computed tomography (CT) images of patients. Two hundred thirty-five patients (127 male, 108 female) were included in the study. The mean patient age was 44.2 years (19-78 years). The measured parameters of the lamina were the transverse inner diameter, transverse outer diameter (lamina width), lamina length, subdural space (safe zone), and spinolaminar angle for each lumbar level (L1-L5).Results: The mean transverse outer diameter (L1-L5) ranged from 7.2-7.8 mm, and mean transverse inner diameter ranged from 2.5-3.0 mm. The lamina of L3 had the largest width and the lamina of L1 and L5 the smallest. The mean lamina length was 26.6 mm, ranging from 21.0-34.0 mm, and the mean spinolaminar angle was 124.7°, ranging from 111-135°. The L1 level had the shortest mean lamina length and L4 the lowest spinolaminar angle. Mean subdural space (safe zone), which was narrowest at the L5 level, was 2.4 mm, ranging from 1.3-3.6 mm.Conclusion: ILS of the appropriate size (3.5-4.5 mm) and length (20 and 25 mm) can be used safely in the lumbar spine. However, further biomechanical studies should be performed to measure strength of the fixatio

Conservative treatment of anterior inferior and superior avulsion fractures of spina iliaca in adolescent amateur footballer

The anterior inferior iliac spine (AIIS) and the anterior superior iliac spine (ASIS) avulsion fracture is a rare injury of pelvis. It usually occurs during the sport activities especially in football while hitting the ball. It is commonly misdiagnosed so that a detailed history and physical examination have a great importance. We present two cases of AIIS and ASIS avulsion fracture. Both of the patients applied to outpatient clinics with hip pain and difficulty in walking. History revealed the complaints started after hitting the ball during the football match and hip movements were limited. The patients were fifteen and sixteen years and after physical examination and radiological evaluation, avulsion fracture of the AIIS and the ASIS were diagnosed. Patients were treated conservatively with non-steroidal anti-inflammatory drugs and limited weight bearing with crutches for a month. The patients were free of pain and had full range of hip movements after one month period. At the end of the second month patients returned to active sports. AIIS and ASIS avulsion fractures are more common in adolescent football players but clinicians sometimes fail to diagnose this rare injury. We emphasize the importance of the detailed history and clinical examination and direct radiography could be enough for the diagnosis

Investigation of knee pain in osteoarthritic and neuropathic pain awareness

The mechanism of neuropathic pain (NP) and osteoarthritic (OA) pain, although different, are both defined as chronic pain, and combinations are possible. In this study, the awareness of both types of chronic pain was investigated among patients and doctors. This prospective study was planned and coordinated by the orthopedic and internal medicine clinics and included 100 patients with a diagnosis of knee OA evaluated with the DN4 questionnaire. Patients with an OA diagnosis included those with NP linked to diabetes and those without NP, and these groups were compared using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritic Index (WOMAC). Data analysis of both groups focused on descriptive statistics of demographic and clinical characteristics. Twenty-four of the patients with type 2 diabetes mellitus (DM) were diagnosed with NP according to DN4 criteria, and began treatment. Of these patients, 21 (84%) had DM for 10 years or more, while 19 (86.4%) had HbA1c of 7 and above. The average WOMAC pain score for patients with NP was 4.33 ± 1.2 while the score for VAS was 8.25 ± 0.8. Patients without NP had a WOMAC pain score of 2.49 ± 0.6 and a VAS of 6.28 ± 1.8. It was observed that in these two knee OA patient groups, NP had a statistically significant enhancing effect on the WOMAC pain score and the VAS (p < 0.001). As underlying pathophysiological mechanism of pain caused by OA is complex, and OA is considered to have a component of NP, it has been proven to be useful to use drugs apart from conventional treatments for NP. We believe that, as a source of pain that is not relieved after arthroplasty, awareness level of NP among orthopedists should be increased and multidisciplinary studies are required on this topic

Preventive effects of coenzyme Q(10) (CoQ(10)) on steroid-induced osteonecrosis in rats

oktay, murat/0000-0002-0893-4444WOS: 000335199800019PubMed: 24747633Objective: The aim of this study was to examine the role of coenzyme Q(10) (CoQ(10)) in the prevention of steroid-induced osteonecrosis of the femoral head (ONFH) in rats. Methods: The study included 20 Sprague-Dawley rats injected once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle to induce osteonecrosis. Animals were divided into two equal groups; Group 1 received no prophylaxis (control group) and the Group 2 received CoQ(10). Hematological examinations were performed before steroid injection (0 weeks) and at 4 weeks after steroid injection. Femoral heads were examined histologically to evaluate osteonecrosis. Results: Changes in blood glutathione (GSH) and malondialdehyde (MDA) concentrations were less significant in the CoQ(10) group. The incidence of histologic changes consistent with early osteonecrosis was lower in the CoQ(10) group (2 of 10; 20%) than the control group (7 of 10; 70%). Conclusion: Coenzyme Q(10) may be useful as a preventing agent in steroid-induced ONFH. Inhibited oxidative stress is a possible mechanism for this effect

Koenzim Q10 (CoQ10)’nun sıçanlarda steroide bağlı osteonekroz üzerine önleyici etkisi

Amaç: Bu çalışmanın amacı koenzim Q10 (CoQ10)’nun sıçanlarda steroide bağlı femur başı osteonekrozu (FBON) üzerindeki önleyici etkilerini incelemekti. Çalışma planı: Osteonekrozu indüklemek için, 20 Sprague-Dawley cinsi sıçanın sağ gluteus medius kası içerisine bir kez 20 mg/kg metilprednizolon asetat enjekte edildi. Hayvanlar iki eşit gruba ayrıldı: 10 sıçandan oluşan Grup 1’e (kontrol grubu) profilaksi uygulanmazken, 10 sıçandan oluşan Grup 2’ye CoQ10 verildi. Steroid enjeksiyonu yapılmadan hemen önce (0. Hafta) ve steroid enjeksiyonundan 4 hafta sonra hematolojik incelemeler yapıldı. Osteonekrozu değerlendirmek amacıyla femur başları histolojik olarak incelendi. Bulgular: Kandaki glutatyon (GSH) ve malondialdehit (MDA) konsantrasyonlarına dair değişiklikler CoQ10 grubunda daha az belirgin idi. CoQ10 grubunda erken osteonekroz ile uyumlu histolojik değişikliklerin görülme sıklığı (10 sıçandan 2’si; %20) kontrol grubuna (10 sıçandan 7’si; %70) kıyasla daha düşüktü. Çıkarımlar: Koenzim Q10 steroide bağlı FBON’yi önleyici bir ajan olarak yararlı olabilir. Oksidatif stresin inhibe edilmesi bu etkiyi açıklayabilecek olası bir mekanizmadır.Objective: The aim of this study was to examine the role of coenzyme Q10 (CoQ10) in the prevention of steroid-induced osteonecrosis of the femoral head (ONFH) in rats. Methods: The study included 20 Sprague-Dawley rats injected once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle to induce osteonecrosis. Animals were divided into two equal groups; Group 1 received no prophylaxis (control group) and the Group 2 received CoQ10. Hematological examinations were performed before steroid injection (0 weeks) and at 4 weeks after steroid injection. Femoral heads were examined histologically to evaluate osteonecrosis. Results: Changes in blood glutathione (GSH) and malondialdehyde (MDA) concentrations were less significant in the CoQ10 group. The incidence of histologic changes consistent with early osteonecrosis was lower in the CoQ10 group (2 of 10; 20%) than the control group (7 of 10; 70%). Conclusion: Coenzyme Q10 may be useful as a preventing agent in steroid-induced ONFH. Inhibited oxidative stress is a possible mechanism for this effect